The fascial closure portion of any surgical case is critical. A well preformed minimally invasive surgery can result in a complication if this final portion of the case is neglected or done poorly. Any abdominal wall defect greater than 8 mm should be accompanied by a fascial closure to reduce the risk of incisional hernia. Incisional hernias can be very costly complications. They lead to increased hospital stays; increased patient pain and suffering; and most often times an ensuing operation. Incisional hernias can also be life-treating if the bowel becomes strangulated and ischemic. The rates of incisional hernia have been alarmingly high in single incision minimally invasive techniques and have prevented such techniques from becoming more widely adapted as the standard of care.
The current technologies and devices for port site fascial closure are antiquated and require an immense amount of skill to use. Therefore, the results are not widely reproducible even in the most talented hands. The embodiments described herein will allow the integration of computer aided surgery (robotics) into the fascial closure portion of a case. As computer aided surgery continues to progress, automation will become more accepted and adopted. With automation, surgery will become safer, more uniformly reproducible and efficient. This could potentially impact overall patient outcomes, access to surgical care; and reduce overall cost by eliminating human error from the surgical suite. The disclosed embodiments will help continue the progression and widespread integration of single incision minimally invasive surgery and computer aided surgical techniques. Suture management is a problematic technical skill for robotic surgeons in general surgical cases such as ventral and incisional hernia repair Suture management is crucial during robotic surgeries of the GI tract and abdominal wall. An efficient management of suture can lower the cost of each case by reducing console and overall operating room times. Currently, when the suture is introduced into the robotic surgical field, it is unorganized and tangled. The suture is at the risk of knotting, breaking or incidentally being cut while it is being organized to begin closing a ventral defect or affixing a mesh to the anterior abdominal wall. Sometimes to avoid this issue of un-manageable suture, surgeons will reduce the length of the suture. This prevents difficulty with suture management but often contributes to multiple lengths of suture introduced by an assistant throughout the case. This practice can be time consuming. This practice can also potentially have a higher risk of a retained foreign body or incorrect counts by using multiple needles to complete one case.